Adaptation of the First Episode Psychosis Services -- Fidelity Scale for use in New and Small Programs

Introduction: Fidelity assessments can support healthcare services to deliver care consistent with best practices. However, early psychosis (EP) fidelity assessment tools typically require a volume of service data that is often unavailable to small or new programs. In this study, we pilot a formative fidelity assessment approach to address these challenges. Methods: A formative assessment approach to using the First Episode Psychosis Services – Fidelity Scale (FEPS-FS) was developed to enable the assessment of small and new EP programs. Over 48 months, EPI-CAL EP learning health care network programs completed standard FEPS-FS fidelity assessments, formative assessments for new programs, or formative assessments for small programs, depending upon program eligibility. Results: Of 27 remote fidelity assessments completed with EP programs across California, nine (33.3%) had insufficient service data to complete a standard FEPS-FS assessment. Utilizing the proposed formative assessment approach, one program met the criteria for a new program assessment, and seven a small program assessment. In the new program assessment approach, 34 of 36 items could be assessed. In the small program assessments, a median of 19 items was scored, with a mean FEPS-FS score range from 3.45 to 4.12. Conclusion: These findings suggest that a formative approach to fidelity assessment can generate a meaningful amount of data, capture known variability between programs, and potentially identify areas for service improvement to enhance quality for small and new programs. However, critical data regarding the delivery of pharmacological and psychosocial care were not captured, highlighting the limitations of the approach. Supplementary Material File (different feps-fs types final.docx) - Download - 250.99 KB Information & Authors Information Version history Peer review timeline Published Early Intervention in Psychiatry Version of Record10 Mar 2026Published Copyright This work is licensed under a Non Exclusive No Reuse License. Collection

Authors Metrics & Citations Metrics Article Usage 217views 127downloads Citations Download citation Mark Savill, Briana Sepulveda, Lindsay Banks M, et al. Adaptation of the First Episode Psychosis Services -- Fidelity Scale for use in New and Small Programs. Authorea. 05 September 2025. DOI: https://doi.org/10.22541/au.175707915.57674738/v1 DOI: https://doi.org/10.22541/au.175707915.57674738/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu.