Understanding Coordinated Specialty Care Best Practice Through Fidelity Practices: A Qualitative Exploration
Date of Degree
Dr. Brandon Kohrt
fidelity, coordinated specialty care, learning health systems, early psychosis
Background: Coordinated Specialty Care (CSC) is a multidisciplinary care model for providing care to youth and young adults having their first episode of psychosis. While outcomes of CSC effectiveness are overwhelmingly positive, and widespread implementation has occurred in all US states and territories, what is CSC best practice regarding components and fidelity to the model is not clear. CSC implementation is well documented from a fidelity to the model standpoint, but the highly variable fidelity practices and versions of the model are not well understood. Nor are the experiences of those who deliver or receive care. Adding to the complexity of this gap, it has been identified that what senior CSC providers feel are the most essential components does not match those practices that are most supported in the research. This gap indicates that what is considered most important to providers is not what receives the most research attention or fidelity monitoring relevancy.
Objective: The purpose of this study is to describe how Coordinated Specialty Care program clinicians and decision-makers experience fidelity monitoring and what components of the CSC fidelity model are most relevant to them.
Methods: Using an instrumental case study design, data was collected using semi-structured interviews. Coding and theme creation happened through a constant comparison approach and both inductive and deductive coding. In order to support the real-world impact goal of this project, the analysis also employed Interpretive Description. With Interpretive Description, one can identify the complex experiences and meaning of phenomena using patterns and themes while also accounting for the variations in practice through the thematic analysis procedures commonly used in qualitative methodologies (Thorne et al., 1997). The aim of translational health research is to ensure results have a clinical impact, and Interpretive Description allows for the tension of this dialectic to create new knowledge (Thorne, 2016; Thorne et al., 1997). Participants were recruited using purposive sampling. The target population for recruitment was clinicians and program decision makers who are members of CSC programs that currently undergo fidelity reviews and monitoring practices. All participants completed informed consent prior to participating in an audio-recorded Zoom interview.
Results: A total of 14 participants were interviewed. Participant characteristics represent four different CSC programs, three regions of the US, and varying years of experience in CSC. The analyses resulted in 27 codes, which were compiled into 13 categories, and then created 7 themes; fidelity and CSC defined, the fidelity review process, facilitators and barriers of CSC fidelity monitoring, fidelity monitoring’s impact and measurement, pros and cons of model and fidelity monitoring, shared decision making and flexibility, and changes to make to CSC.
Conclusion: To date, CSC is a multi-component model of care that has been implemented according to fidelity guidelines. The findings of this dissertation suggest that what is key to CSC is flexible implementation of the model components and shared decision making. These salient components are possibly being lost in the gap between the assumed impact of current fidelity metrics and the intended impact. Therefore, a bi-directional pathway between CSC practice, research and policy that centers the experiences and outcomes of clients and families receiving CSC has potential implications for better understanding what CSC best practice is.
Read, Halley, "Understanding Coordinated Specialty Care Best Practice Through Fidelity Practices: A Qualitative Exploration" (2023). Doctor of Philosophy in Translational Health Sciences Dissertations. Paper 22.
©2023 by Halley Read. All rights reserved.