Redesigning a Fidelity Measurement Tool for Early Psychosis Services: Responding to Evolving Service Landscapes in Australia.

Authors

Carly S Talarico, Shona Francey, Craig Hamilton, Kirsten Cleland, Vidhi Oberoi, Vanessa Skellern, Yong Ly, Alyssa Milton, Ellie Brown

Published in

Early intervention in psychiatry. Volume 20. Issue 9. Pages e70263.

Abstract

In Australia, early implementation of headspace Early Psychosis (hEP) services was supported by fidelity assessments using the Early Psychosis Prevention and Intervention Centre (EPPIC) Model Integrity Tool (EMIT). Its suitability became limited by ceiling effects and limited sensitivity to evolving service contexts. This paper describes the redevelopment of EMIT into the Revised-EMIT (REMIT) and testing implementation of the tool.
A multi-phase mixed-methods, human-centred design approach was used. Phases included reviewing international fidelity frameworks, stakeholder co-design and iterative redevelopment of fidelity items, scoring and data sources. Testing of the REMIT occurred over 2 years via face-to-face visits to hEP clusters, using semi-structured interviews, review of organisational documents and clinical file audits. Routine data reporting via Tableau embedded Learning Health System principles within the process. National fidelity trends across fidelity item outcomes for all six hEP service clusters were descriptively analysed.
The REMIT was found to reduce ceiling effects and improve sensitivity. National mean REMIT score increased from 3.99 (2023) to 4.19 (2024), with notable gains in caseload management, physical health monitoring and measuring key outcomes. Relational domains (such as continuous engagement and family involvement) remained persistently low across services and years.
The REMIT offers a pragmatic, sensitive fidelity measure for contemporary hEP services. Findings support the use of REMIT as an active learning system rather than a static compliance mechanism. Psychometric evaluation of the tool is now required, and ongoing iterative refinement will be essential to maintain relevance within Australia's evolving youth mental health system.

PMID:
42785726
Bibliographic data and abstract were imported from PubMed on 25 Sep 2026.

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