Fairweather Lodge Fidelity Standards

Principles, Practices, Outcomes and Satisfaction

 Fidelity to the principles and practices of the Fairweather Lodge is important for a number of reasons.  But participant outcomes and participant satisfaction are a test of fidelity at least as important to the spirit of the Fairweather Model as any checklist of programmatic elements.  A comprehensive assessment of Lodge success, therefore, involves: 1) Adherence to the Lodge Principles; 2) Implementation of Lodge Practices; 3) Demonstrated Outcomes; and 4) Participant Satisfaction (see page 6). 
 

Principles

In his ground-breaking 1963 book, Community Life for the Mentally Ill, Dr. Fairweather established thirteen principles for successfully integrating people with mental illness into the community.  Although all thirteen were valid at the time, the eight principles updated for this assessment tool are those which remain relevant to distinguishing the unique values of a Fairweather Lodge.  A program which is at odds with these principles might be a wonderful program, but it is not a Fairweather Lodge.
 

Practices

Over the last forty years, as practitioners have experimented with the Lodge Model, a wide variety of practices have been implemented with various degrees of success.  The sixteen practices selected for this assessment are those which have enjoyed the greatest success.  We recognize that conditions vary from one setting to the next, and that the most successful practitioners are those who can adapt to local conditions, but these sixteen practices are highly recommended, especially for new programs.
 

Outcomes

We presume that anyone associated with a Fairweather Lodge will have a philosophical affinity for the values defined by the eight Principles and sixteen Practices.   And it is easy to get engrossed in implementing the principles and practices while at the same time struggling to obtain/maintain funding, hire/supervise staff, recruit/ screen participants.  But hopefully, the reason practitioners choose the Lodge Model in the first place is because of the potential outcomes, and any assessment of Lodge success needs to examine the outcomes produced. 

Housing, Employment, Social and Autonomy

Although a Fairweather Lodge is understood to be a package of highly-integrated services, we have broken the assessment into four domains for the purpose of evaluation.  Surveys of the needs/wants/desires of people with serious mental illness provide three obvious domains -- housing, employment, and a social life.  To this we add the uniquely Fairweather perspective of group autonomy.  A successful Fairweather Lodge should score well across all four domains.
 

Housing

Principle I.  The lodge must provide a safe, healthy and caring environment, which reinforces the recovery process.

Practice A. Lodges should be located in a safe and accepting neighborhood.

Practice B.. Lodges should be attentive to exercise and nutrition.

Practice C.. Lodges should control the use of alcohol and street drugs

      Proposed Outcome Measures:

Number of undesirable interactions (e.g., getting mugged, name-calling) in the neighborhood per participant-year, (or versus desirable interactions.)

Percentage of participants eating healthy.

Percentage of participants exercising regularly.

Percentage of participants using drugs or alcohol.

                                   OR

4.a Undesirable incidents related to drugs or alcohol.

Principle II.  The Lodge must be part of the plan for managing symptoms and promoting good mental health.

Practice D. Good quality psychiatric care (implying a doctor-patient partnership) should be available.

        Proposed Outcome Measure #5:

Average length of wait for non-routine psych visit.

Practice E. Lodges should have a standard mechanism for ensuring medication compliance (This mechanism should be adjustable in response to variance in earned autonomy.)

       Proposed Outcome Measure #6:

Percentage of medications taken as prescribed.

Principle III. Services must be available as long as the participant wants and needs them.

Practice F. (Except as established by the Lodge) There should not be any minimum or maximum time limits on participation.

Satisfaction

Although choices are often limited by an under-developed community mental health system, the Fairweather philosophy is based on the assumption that Lodge members participate voluntarily.  One of the implications of voluntary participation is that adherence to the principles, implementation of the practices, and even the production of desirable outcomes, are meaningless unless the participants are satisfied that their basic needs are being met. 

Most surveys of the needs/wants/desires of people with serious mental illness produce the same general results with respect to the BIG 3 (not always in the same order): a “nice place to live,” a “good job, ” and friends.  It is a given that a Lodge provides housing, but is it a “nice place to live?”   Does the employment provided meet the standard of a “good job?”  Are the other participants really “friends?”  And does allegiance to the autonomy principles and a low staffing ratio actually produce empowerment?  The most direct way to answer these questions is to ask the participants.

However, one limitation of satisfaction surveys is that some people always express satisfaction, even while planning to leave the program, and others will complain bitterly for years but never contemplate leaving.  (This phenomenon is not exclusive to mental illness.)  It is important, therefore, to measure retention -- a less direct, but potentially more telling strategy for measuring satisfaction.  So we add:

Proposed Outcome Measure #15:

The percentage of participants, at a given starting point, still participating at a certain benchmark.

Public Interest

The taxpaying public has a legitimate interest in the cost-effectiveness of any program supported with public funds.  So even though it is an imperfect measure of Lodge success, and not necessarily tied to the Lodge mission, we add:

Proposed Outcome Measure #16:

Number of days of in-patient psych hospitalization as percentage of participant-days.

Lodge Member Satisfaction Survey