The Clinical Strategies Implementation Scale Revised (CSI-R). Fidelity Assessment of Resource Group Assertive Community Treatment


The Clinical Strategies Implementation scale (CSI) was originally designed to be used by external reviewers in order to measure the extent to which evidence-based strategies had been implemented in the treatment of persons with schizophrenia spectrum disorders according to Resource-group Assertive Community Treatment (RACT). The present investigation had two aims: 1) to conduct a revision of CSI and to examine the revised instrument (CSI-R) in terms of interrater reliability (Study I); 2) to compare assessments of CSI-R made by experienced assessors with assessments made by students in case management (Study II) in order to determine whether the instrument has validity even when more inexperienced persons are using it. In Study I six raters, who took part in 12 to 15 cases from three outpatient community mental health teams, participated. Results indicated that internal consistency of the CSI-R was strong (alpha = 0.89) as well as correlations between individual raters’ (r between 0.80-0.98). In Study II 91 newly trained RACT praxis trainees participated. Each of them followed one case for eighteen months, i.e., the client which they had been assigned during training (n = 91). The five external auditors in the education program then independently assessed the 91 cases with the CSI-R. Results showed significant correlations between experts and trainees (rho = 0.68, p < 0.001). The conclusion was that the new CSI-R scale was shown to have acceptable internal consistency and interrater reliability and may be used for continuous self-monitoring of praxis fidelity by inexperienced raters.

Share and Cite:

J. Andersson, B. Ivarsson, S. Tungström, U. Malm and T. Norlander, "The Clinical Strategies Implementation Scale Revised (CSI-R). Fidelity Assessment of Resource Group Assertive Community Treatment," Open Journal of Medical Psychology, Vol. 3 No. 1, 2014, pp. 36-41. doi: 10.4236/ojmp.2014.31004.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] The Lewin Group, “Assertive Community Treatment Literature Review. Prepared for Health Care and Financing Administration and Substance Abuse and Mental Health Services Administration,” The Lewin Group, Falls Church, 2000.
[2] L. L. Stein and A. B. Santos, “Assertive Community Treatment of Persons with Severe Mental Illness,” Guilford Press, New York, 1998.
[3] G. Thornicroft and M. Tansella, “Better Mental Health Care,” Cambridge University Press, Cambridge, 2009.
[4] I. H. R. Falloon and the Optimal Treatment Project Collaborators, “Optimal Treatment for Psychosis in an International Multisite Demonstration Project,” Psychiatric Services, Vol. 50, No. 5, 1999, pp. 615-618.
[5] I. Falloon, I. Montero, M. Sungur, A. Mastroeni, U. Malm, M. Economou, R. Grawe, J. Harangoso, M. Mizuno, M. Murakami, B. Hager, T. Held, F. Veltro, R. Gedye and Tht OTP Collaborative Group, “Implementation of Evidence-Based Treatment for Schizophrenic Disorders: Two-Year Outcome of an International Field Trial of Optimal Treatment,” World Psychiatry, Vol. 3, No. 2, 2004, pp. 104-109.
[6] T. Nordén, A. Eriksson, A. Kjellgren and T. Norlander, “Involving Clients and Their Relatives and Friends in the Psychiatric Care. Case Managers’ Experiences of Training in Resource Group Assertive Community Treatment,” PsyCh Journal, Vol. 1, No. 1, 2012. pp. 15-27.
[7] T. Nordén, U. Malm and T. Norlander, “Resource Group Assertive Community Treatment (RACT) as a Tool of Empowerment for Clients with Severe Mental Illness: A Meta-Analysis,” Clinical Practice & Epidemiology in Mental Health, Vol. 8, 2012, pp. 144-151.
[8] B. J. Associates, “Evaluation Brief: Measuring Implementation Fidelity,” Author, Arlington, 2009.
[9] C. T. Mowbrey, M. C. Holter, G. B. Teague and D. Bybee, “Fidelity Criteria: Development, Measurement, and Validation,” American Journal of Evaluation, Vol. 24, No. 3, 2003, pp. 315-340.
[10] G. R. Bond and M. P. Salyers, “Prediction of Outcome from the Dartmouth Assertive Community Treatment Fidelity Scale,” CNS Spectrums, Vol. 9, No. 12, 2004, pp. 937-942.
[11] M. Monroe-DeVita, G. B. Teague and L. L. Moser, “The TMACT: A New Tool for Measuring Fidelity to Assertive Community Treatment,” Journal of the American Psychiatric Nurses Association, Vol. 17. No. 1, 2011, pp. 17-29.
[12] I. R. H. Falloon, M. Economou, A. Palli, U. Malm, M. Mizuno, M. Murakami and the Optimal Treatment Project Collaborative Group, “The Clinical Strategies Implementation Scale to Measure Implementation of Treatment in Mental Health Services,” Psychiatric Services, Vol. 56, No. 12, 2005, pp. 1584-1590.
[13] T. Nordén, B. Ivarsson, U. Malm and T. Norlander, “Gender and treatment Comparisons in a Cohort of Patients with Psychiatric Diagnoses,” Social Behavior and Personality, Vol. 39, No. 8, 2011, pp. 1073-1086.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.